M00.852
BillableArthritis due to other bacteria, left hip
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M00.852 an HCC code?
Yes. M00.852 maps to Bone/Joint/Muscle Infections/Necrosis under the CMS-HCC V28 risk adjustment model (and Bone/Joint/Muscle Infections/Necrosis under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for M00.852
For M00.852to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed M00.852 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M00.852 is the ICD-10-CM diagnosis code for arthritis due to other bacteria, left hip. Bacterial infection causing inflammation and swelling in the left hip joint, caused by bacteria other than the most common types. M00.852 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering infectious arthropathies (m00-m02).
Under the CMS-HCC V28 risk adjustment model, M00.852 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.209. Under the older V24 model, M00.852 mapped to the same category but with a base RAF weight of 0.482 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Confirm the bacterial organism is identified in the documentation; if unspecified, use M00.859. Because M00.852 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M00.852 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Bacterial arthritis of the left hip represents a surgical emergency requiring immediate intervention to preserve joint function and prevent life-threatening sepsis. This condition can rapidly progress to joint destruction and osteomyelitis if not treated aggressively.
Documentation Requirements
- ✓Documentation of 'other bacteria' as infectious agent
- ✓Clear identification of left hip joint involvement
- ✓Laboratory confirmation of bacterial infection
- ✓Clinical signs of septic arthritis
- ✓Evidence of urgent antibiotic therapy initiation
- ✓Assessment of hip mobility and weight-bearing status
- ✓Inflammatory markers and blood culture results
- ✓Differentiation from adjacent bone or soft tissue infection
Commonly Confused Codes
- •M00052 — Streptococcal arthritis of left hip (different bacterial type)
- •M00015 — Staphylococcal arthritis of left hip (specific organism)
- •M06.852 — Other rheumatoid arthritis of left hip (autoimmune)
- •M16.12 — Unilateral primary osteoarthritis of left hip (degenerative)
- •M86.852 — Other osteomyelitis of left femur (bone infection)